Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1066-1077
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1066
Computer-assisted three-dimensional individualized extreme liver resection for hepatoblastoma in proximity to the major liver vasculature
Wen-Li Xiu, Jie Liu, Jing-Li Zhang, Jing-Miao Wang, Xue-Feng Wang, Fei-Fei Wang, Jie Mi, Xi-Wei Hao, Nan Xia, Qian Dong
Wen-Li Xiu, Jing-Li Zhang, Jing-Miao Wang, Xue-Feng Wang, Jie Mi, Xi-Wei Hao, Qian Dong, Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Jie Liu, Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Fei-Fei Wang, Nan Xia, Qian Dong, Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Shandong College Collaborative Innovation Center of Digital Medicine Clinical Treatment and Nutrition Health, Qingdao University, Qingdao 266003, Shandong Province, China
Co-first authors: Wen-Li Xiu and Jie Liu.
Co-corresponding authors: Nan Xia and Qian Dong.
Author contributions: Xiu WL, Liu J, and Zhang JL contributed to data curation and writing of the original draft; Wang JM, Wang XF, and Wang FF contributed to data curation; Mi J, Hao XW, Xia N, and Dong Q contributed to manuscript review and editing; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82293665; and Anhui Provincial Department of Education University Research Project, No. 2023AH051763.
Institutional review board statement: This study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University (approval No. QYFY-WZLL-25776).
Informed consent statement: This is a retrospective study article, and all guardians of the patients signed the informed consent forms before treatment and surgery. The patient's identity information was not disclosed and will not cause any harm to the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Qian Dong, MD, Professor, Surgeon, Teacher, Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Shinan District, Qingdao 266000, Shandong Province, China.
Received: November 21, 2023
Peer-review started: November 21, 2023
First decision: January 19, 2024
Revised: January 29, 2024
Accepted: March 15, 2024
Article in press: March 15, 2024
Published online: April 27, 2024
Research background

Hepatoblastoma (HB) is usually a large tumor when it is detected clinically. However, there is currently no consensus on the optimal diagnosis and treatment plan for children with difficult HB who are large size and complex locations. Even after a full course of neoadjuvant chemotherapy (NAC), approximately 25% of HB patients remain in close proximity to the major liver vasculature (PMV). In recent years, aggressive extreme liver resection has become another viable option, and computer-assisted three-dimensional (3D) individualized surgical planning has also been proven to be beneficial for surgery.

Research motivation

Children with HB who still have PMV after a full course of NAC pose a clinical challenge in planning further treatment. After computer-assisted 3D individualized evaluation, aggressive extreme liver resection may be another viable option for reducing the need for liver transplantation.

Research objectives

To explore whether computer-assisted three-dimensional individualized extreme liver resection is safe and feasible for children with HB who still have PMV after a full course of NAC.

Research methods

We retrospectively collected data from children with HB who underwent surgical resection at our center from June 2013 to June 2023. Then, we analyzed the clinical characteristics, PMV classification, 3D individualized assessment, preoperative planning and intraoperative and postoperative results of children with HB who still had PMV after a full course of NAC.

Research results

Sixty-seven children diagnosed with HB underwent surgical resection. After a full course of NAC, 16 patients still had close PMV (within 1 cm in two children, touching in 11 patients, compressing in four patients, and having tumor thrombus in three patients). There were 6 cases of tumors in the middle lobe of the liver, and four of those patients exhibited liver anatomy variations. These 16 children underwent extreme liver resection after comprehensive preoperative evaluation. Intraoperative procedures were performed according to the preoperative plan, and the operations were successfully performed.

Research conclusions

Computer-assisted three-dimensional individualized extreme liver resection for HB patients who are still in close PMV after a full course of NAC is both safe and feasible.

Research perspectives

Aggressive extreme liver resection with individualized 3D surgical planning will provide opportunities for surgical resection of difficult HB patients.